| NPI | 1619075470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 200300578) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NC 200300578) |
| 208000000X Pediatrics (Licence: NC 200300578) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-07-12 |